Republicans don’t always oppose the federal welfare state

June 20, 2012

TPM's Brian Beutler argues that "motivated reasoning" doesn't explain Republican behavior in recent years nearly so well as a frame in which you assume "the conservative movement is heavily invested in limiting the size of the federal welfare state, particularly publicly run parts of it."

Matt Yglesias agrees, and says that from that perspective, "the most interesting flip-flop isn't about ObamaCare, it's about the exceptional moment in 2003 when George W. Bush and the Republican congressional leadership—including current tightwad-in-chief Paul Ryan—whipped votes in favor of what was, at the time, the largest expansion of the welfare state since Lyndon Johnson was in office. That was the creation of a prescription drug benefit for Medicare."


Ronald Reagan tried to expand Medicare, too. (Ron Edmonds-AP)

I would agree, but the Medicare Prescription Drug Benefit simply isn't that exceptional. In his 1992 State of the Union, for instance, George H.W. Bush proposed a health-reform plan:

My plan provides insurance security for all Americans while preserving and increasing the idea of choice. We make basic health insurance affordable for all low-income people not now covered. We do it by providing a health-insurance tax credit of up to $3750 for each low-income family. The middle class gets help, too. And by reforming the health insurance market, my plan assures that Americans will have access to basic health insurance even if they change jobs or develop serious health problem We must bring costs under control, preserve quality, preserve choice and reduce people's nagging daily worry about health insurance. My plan, the details of which I will announce shortly, does just that.

Before Bush, it was Ronald Reagan, in 1989, who proposed and signed what was, up till that point, the most significant expansion of an entitlement program since Lyndon Johnson created Medicare:

First, we're asking Congress to legislate acute catastrophic illness insurance for Medicare beneficiaries, most of whom are 65 and over. Under this proposal, Medicare itself would be amended to provide unlimited Medicare coverage. Moreover, our proposal would establish a limit of just $2,000 for out-of-pocket Medicare expenses that can presently run into the many thousands. And we can do all this by adding just $4.92 to the Medicare monthly premium. This is a pay-as-you-go program, a program that requires no tax dollars. Now, what does this mean in practical terms? Well, the answer is simple: peace of mind for some 30 million older Americans. Suppose, for example, that someone over 65 fell and broke a hip. And then suppose that, while still recovering, she contracted pneumonia. A broken hip and pneumonia—that could mean two acute care hospitalizations within the same year, care that would cost thousands. Under Medicare as it stands today, the patient herself would have to pay a significant portion of these costs—and all but the very wealthy would be wiped out. But under our proposal, Medicare itself would pay most costs above $2,000, giving the patient financial security.

You can argue that George H.W. Bush was just trying to blunt the momentum of Democratic health-care plans, which were gaining steam around that time. You can argue that Medicare Catastrophic, which was later repealed, was also unique. But if every Republican president tries to expand the social safety net, then at some point, we have to admit that this is a trend among Republican presidents, rather than a one-off. At the very least, it's hard to hold that Republicans have a consistent investment in limiting the size of the welfare state when they're in power.

Moreover, the examples we have aren't limited to Republican presidents -- or even to periods in which conservatives are fighting a rearguard action against Democratic initiatives. Kevin Drum, for instance, writes that "you don't need to resort to cynicism, motivated reasoning, or even a genuine change of heart to explain" the conservative affection for the individual mandate. It was simply, for Republicans, "the next best alternative" to Clinton's plan, and so they embraced it as a defensive maneuver and abandoned it once the thread had passed.

The problem is that the timing doesn't work. For one thing, the mandate began to rise in conservative circles starting in 1989, when the Heritage Foundation published the brief, "Assuring Affordable Health Care for All Americans.” In 1991, Milton Friedman, the legendary conservative economist, wrote a Wall Street Journal op-ed proposing "a requirement that every U.S. family unit have a major medical insurance policy.” Clinton's plan didn't emerge until 1993. So the underlying Republican policy thinking well predated it.

Moreover, affection for the mandate persisted long after Clinton's plan had passed. Mitt Romney passed a mandate-based plan in Massachusetts in 2005. Newt Gingrich was supporting a mandate-based plan as late as 2009. Between 2006 and 2009, nearly a dozen Senate Republicans signed onto Ron Wyden's mandate-based Healthy Americans Act, and in my New Yorker piece, Wyden notes that he spoke to many more even than that, and rarely if ever heard concerns about the mandate.

The mid-2000s were hardly a high watermark for Democrats or for their health plans, and Clinton's health-care plan was long gone, so it's hard to say what kept the mandate floating around in Republican circles, save that some Republicans actually thought it was a good idea. And you could write something very similar about the Republican interest in cap-and-trade proposals to limit carbon emissions over this period.

All of which is to say that if you took the "strategic ideologue" perspective that Republicans are "heavily invested in limiting the size of the federal welfare state," you would have been surprised by a lot of Republican proposals over the last two decades.

But if you took the "motivated reasoning" perspective in which political parties convince themselves of what's in their self-interest, the proposals make sense, and so does their persistence in the Bush years, as part of the process of Republicans opposing the Clinton bill in the '90s was that many conservatives had persuaded themselves that the health-care ideas underlying their alternatives were sound, and so they continued to work on them in the mid-2000s. Then, in 2009, President Obama's health-care bill gave them an overriding strategic reason to begin the process of changing their minds.

This isn't to say that political parties have no underlying belief systems of note. All else being equal, it's obviously and enduringly true that Republicans are somewhat more skeptical of the safety net than Democrats. But all else usually isn't equal, and the point of the "motivated reasoning" model is to show exactly how far and fast political parties can change what seem to be deeply held opinions in order to adapt to their circumstances.

 

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Brad Plumer · June 20, 2012